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Guidelines in type 1 diabetes american diabetes association, EASD & ISPAD

Welcome to our comprehensive resource hub for type 1 diabetes and exercise! Here, you'll find valuable information, expert recommendations, and useful resources to help you navigate the relationship between T1D and exercise. Whether you're seeking guidelines on managing blood glucose levels during physical activity or searching for practical tips to stay active, we've got you covered. 

The American Diabetes Association (ADA) guidelines cover various exercise types, including aerobic, resistance, and flexibility exercises. Meanwhile, the guidelines from the European Association for the Study of Diabetes (EASD) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) offer valuable insights into the utilization of continuous glucose monitoring (CGM) systems before, during, and after exercise for individuals living with type 1 diabetes.

American diabetes association: Exercise recommendations for people with type 1 diabetes

Aerobic

Repeated, continuous movement of large muscle groups  that primarily depend on the aerobic energy system

150 mins/week (moderate intensity)
75 mins/week (high intensity)

  • Increases insulin sensitivity 
  • Improves lung function 
  • Improves cardiac output
  • Lowers the risk of CV disease

Resistance

Purposeful movements against an external load to improve muscular strength and endurance - primarily target anaerobic metabolic pathways. 

2-3 sessions/week

  • Improves body composition 
  • Improves bone mineral density 
  • Improves blood lipid profiles 
  • Improves overall CV health 

Flexibility

Flexibility or balance exercises may be particularly useful for older adults with diabetes. Can include stretching and balance training.

2-3 sessions/week for older adults
with diabetes

  • Improves range of motion around
    muscle joints 
  • Improves balance and gait 
  • Can reduce the risk of falls 


Learn more

Watch Dr. Peter Adolfsson go through the guidelines in more detail [20 min.] or go directly to the overview with highlights and easy access to the helpful resources provided during the debate. 

Watch the DiaDebate on diabetes and exercise

Read the summary of the DiaDebate

 

EASD/ISPAD: Position statement recommendations for the use of CGM systems with exercise in people with type 1 diabetes

General points to consider

... before exercise

  • Know type, intensity and duration of activity
  • Consider timing of exercise
  • Know how much insulin is on board
  • Target a sensor glucose range based on exercise routine and risk of hypoglycemia, accompanied by adequate trend arrow

... during exercise

  • Target sensor glucose ranges should be 126-180 mg/dL and slightly higher for those with increased risk of hypoglycemia
  • If at glycemic threshold of 126 mg/dL, accompanied by the following trend arrows:
    •  10-15g of carbohydrates should be consumed
    •  15-25g of carbohydrates should be consumed
    •  20-35g of carbohydrates should be consumed
  • If sensor glucose levels are elevated (<270 mg/dL), insulin correction may be performed (50% of regular correction factor), and ketone levels should be monitored
  • Exercise should be stopped if sensor glucose levels reaches <70 mg/dL; if below <54 mg/dL, exercise should not be re-started

... after exercise

  • During the first 90 mins following exercise, aim for a glucose sensor target of 80-180 mg/dL; consumer ~10-15g of carbohydrates if at the lower glucose limit based on the trend arrow 
  • If insulin correction is applied due to high sensor glucose levels, consider reducing the regular correction by up to 50%
  • CGM alarm should be set to 80 mg/dL; those using isCGM system should perform at least one scan during the night time period

T1D and exercise: Learn more

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